Wherein an adult student of oboe chronicles her adventures in music, medicine, and faith, and other stories...
“Novelists, opera singers, even doctors, have in common the unique and marvelous experience of entering into the very skin of another human being. What can compare with it?” -Willa Cather

Monday, October 13, 2008

Grand Rounds!

Welcome to Grand Rounds!

Today I've organized Rounds into six major sections (each preceded by a self-indulgent little nod to a movie from my personal list of favorites):

1. School Days - posts about our training experiences and their aftermath

2. Stories from the Trenches - one of the reasons I read medical blogs at all

3. Educational Materials - it's Grand Rounds, after all; but I'm optimistic that our audience won't have their heads nodding onto the back wall of the lecture hall as they helplessly snooze through some slides... :)

4. From the Patients' Side

5. Politics, Economics, "Systems" Errors, and Controversies

6. Medical Blogging: issues upon issues, now and forever

But first, a Prologue. Ramona Bates, M.D., author of the blog Suture for a Living, reprinted this essay on Why Michelangelo Studied Cadavers, and I think it's a great way to start. It's a reflection on the characteristics that allow people to attain success. Something to think about!

School Days

Mother Superior: The band will perform in their gym suits.

Rachel: Our GYM suits?! But they're AWFUL, Reverend Mother.

Mary: It's not as if we were like Sacred Heart. At Sacred Heart they wear short shorts for gym.

Next, the med school and residency years. DB offers some thoughts and quotations about medical educators. Medical student Jeff Leow muses on how our future responsibilities haunt us even as we prepare for them, for tasks as simple as obtaining I.V. access. During a tough month in the NICU for umbilical lines Beth doesn't take it for granted when hers goes in and learns why patience is a virtue. PathRes tells us what being on call during pathology residency is like. And just for fun, Check out the entertaining speculation on The Dragonfly Initiative on what it might be like if the characters from Heroes went to medical school.

Dr. Gurley takes us back to those professional patients who volunteered to let us learn how to do pelvic and rectal exams correctly. Remember that day? And how surreal it was to get actual feedback from these helpful patients who were willing to let us invade their privacy so we could do right by our future patients?

Finally, the years that follow. Jordan looks back at the layers of expectation that have been peeled away by the training experience to reveal a more nuanced primary care practice. And speaking of not having to practice according to the textbook, Dr. Zhang describes skipping over the usual rituals to deal with the hiccup boy. Bongi describes how despite their years and years of residency training, general surgeons still have to deal with people making the wrong assumptions about them. And Fat Doctor encourages students and residents who are still on that long road to take heart - you do come out better in the end.

Stories from the Trenches

Dr. Okun: The neatest suff has only happened in the last few days. See, we can't duplicate their type of power, so we've never been able to experiment. But since these guys started showing up, all the little gizmos inside turned on. (laughs) The last 24 hours have been really exciting.

President Whitmore: "Exciting?!" People are dying out there! I don't think "Exciting" is the word I'd choose to describe it!

Here's the latest by Pathmom from Mothers in Medicine. If you're a working mom and can't relate to this, you either haven't been working long enough or haven't been a mom long enough, or you're perfect, or your kids are perfect.

Bongi describes removing a "tumbler" -a bullet that wrought more havoc than its not-too-high-velocity might have suggested.

Just discovered a great blog, Mulberry Street, written by Jonathan, a senior anesthesia resident who wrote this post about a tough intubation for a dying patient. Not for the faint of heart (or stomach). No, Jonathan, you should NOT get a desk job - we need you.

But it's not all sorrow and loss. Here's a story of hope from FreshMd.

Educational Materials

Santa: I've been to New York thousands of times.

Buddy: Really?

Santa: Mm-hmm.

Buddy: What's it like?

Santa: Well, there are some things you should know. First off, you see gum on the street, leave it there. It isn't free candy.

Buddy: Oh.

Santa: Second, there are, like, thirty Ray's Pizzas. They all claim to be the original. But the real one's on 11th. And if you see a sign that says "Peep Show", that doesn't mean that they're letting you look at the new toys before Christmas.

The tradition of Grand Rounds evolved as a forum for educating physicians. Here are a few informative posts on a variety of topics:

First, a post on a subject near and dear to me: AIR. PalMD gives us "Breathing 101" on the Denialism blog.

Medical videographer Sterile Eye highlights the invention of the triangulation method for suturing of blood vessels in his fascinating look back at Nobel prize-winning surgeon Alexis Carrel.

Pallimed gives us a history of the concept of brain death. Lots to think about!

Ramona Bates just re-posted a helpful, informative review of mammograms. Her blog Suture for a Living is always worth a visit; don't miss her recent hosting of the blog carnival SurgeXperiences, which includes a section on surgery in the news.

Amy Tenderich of DiabetesMine reminds us of the very basic fact the patients are people (kinda like doctors...see above for those reminders).

Surgeon and best-selling author Pauline Chen reviews the book Sick Girl by Amy Silverstein and describes how it helped her understand the way patients make decisions. Check out her column too on The Dance Before the Diagnosis.

Duncan Cross tells the story of a visit to the dermatologist that will make anyone who cares about patient care and comfort cringe.

Many patients face issues of chronic pain and its impact on day-to-day life. Jolie Bookspan provides valuable advice on how to minimize the strain of autumn yard work and keep fit despite problems such as rheumatoid arthritis.

An Australian doc tackles the issue of emergency department waiting room deaths. "The evidence is plain to see, easy to read, and possible to fix." Then why aren't we doing better? (See here and here for some attorneys' posts on waiting room deaths.)

And it's high time we had some intelligent, in-depth, meaningful discussion, regardless of political or religious beliefs, on the fact that Pro-Life Can Mean Death for Women in the Third World, as Toni Brayer of EverythingHealth points out.

Medical Blogging: the Issues May Never Die

Sir Kay (after Arthur points to where he wants to set up camp for the night):It's too exposed, Sire. We could never possibly defend.

Finally, Buckeye Surgeon offers this thought-provoking post on why he "came out" in the blogosphere. If it hadn't been for my kids, I might have considered doing the same...might still do it...although I find Buckeye's own travails dealing with people invading his family's privacy discouraging, so for now, I'll stick to the blog persona.

It's a Wrap!

That's it, folks! Time to go back to clinic / the O.R. / the lab!

For those who, like me, enjoy rounding further in the medical blogosphere, White Coat Rants's blog links might be helpful.

Thank you to everyone who submitted posts for this edition of Grand Rounds, and to all who didn't submit but got volunteered to be in it anyway, by me! Please tune in next time when it will be hosted by Christian Sinclair, M.D. at Pallimed.

I have not followed Grand Rounds. Maybe the different themes didn't work for me. You organized everything well, summarized everything, and pointed out some important blogging issues. I would have use the Princess Bride quote for the part on blogging, but that's just my way of looking at things.

Scoping things out

About Me

I'm a wife & mom. I'm a doctor too. I listen to classical Christmas carols all year round (they make me happy). I also love to read, write, cook, eat, dance, play music, and ponder things. I do a lot of my pondering here.

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*FINALIST* for BEST LITERARY MEDICAL BLOG OF 2008

Practicalities

1. Please don't take anything you read here as medical advice.2. Please be courteous when leaving comments.3. Comments reflect only the opinions of the individuals leaving them; I won't delete them, even if they go against my own opinions and beliefs, UNLESS they are written offensively or disrespectfully.4. All patient identifiers have been removed or altered to protect patient privacy. Most other proper names used here have been changed as well, unless the change has seemed unnecessary for fairly obvious reasons, or the individuals named somehow indicated to me that they did not mind being identified.

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Journal Club (added 5/30/07)

In med school & residency there was "Journal Club" - a kill-me-now-to-put-me-out-of-my-freakish-misery type of exercise during which we were supposed to exchange ideas about a paper from an academic medical publication. I couldn't think of a less appealing way to spend my time.
But here's a different kind of Journal Club - the FUN kind. Pick a journal writing question, write a response, get together with a bunch of friends who love to do this kind of thing, read your answers to each other, and share thoughts. Make up your own questions, write, & read some more. Make sure you have lots of good food and drink to share!

Journal Writing Questions

Why do you write?

What is your idea of success?

What do you spend enormous amounts of energy on? Why?

Who / what has influenced you?

What belief do you hold most dear? What does your faith consist of? What do you refuse to believe?

If you could interview anyone, living or dead, fictional or real, whom would you choose and why?